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Collection of peripheral blood progenitor cells after the administration of cyclophosphamide, etoposide, and granulocyte‐colony‐ stimulating factor: an analysis of 497 patients
Author(s) -
Weaver C. H.,
Schwartzberg L. S.,
Birch R.,
Greco F. A.,
Hainsworth J.,
Beeker T.,
Price H.,
Geier L.,
Foster J.,
West J.,
Hazelton B.,
Buckner C. D.,
Rhinehart S.
Publication year - 1997
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1997.37997454014.x
Subject(s) - etoposide , granulocyte colony stimulating factor , medicine , cyclophosphamide , cd34 , regimen , chemotherapy , progenitor cell , gastroenterology , urology , immunology , stem cell , surgery , biology , genetics
BACKGROUND: There is great interpatient variability in the number of peripheral blood stem cells collected, as measured by CD34+ cell content, after the administration of chemotherapy and a growth factor. The ability to predict patients who fail to yield adequate quantities of CD34+ cells would be of value. However, very few reports include large numbers of patients treated in an identical fashion. STUDY DESIGN AND METHODS: Between 1991 and 1995, 497 consecutive patients with a variety of malignant diseases received cyclophosphamide (4 g/m2), etoposide (600 mg/m2), and granulocyte‐colony‐stimulating factor (6 micrograms/kg/day) for mobilization and collection of a target dose > or = 2.5 × 10(8) CD34+ cells per kg. Multivariate analyses were performed to determine the factors associated with failure to achieve this target harvest. RESULTS: A median of 14.71 × 10(6) CD34+ cells per kg (range, 0.08‐137.55) was harvested with a median of 2 (range, 1–11) apheresis procedures. Ninety‐one percent of patients yielded > or = 2.5 × 10(5) CD34+ cells per kg. Patients with Stage II‐III breast cancer, who had pretreatment platelet counts > or = 150 × 10(9) per L and patients who underwent < or = 1 prior chemotherapy regimen had improved CD34+ cell yields. However, most patients with adverse risk factors yielded > or = 2.5 × 10(6) CD34+ cells per kg. CONCLUSION: A regimen of cyclophosphamide, etoposide, and granulocyte‐colony‐stimulating factor led to the successful collection of adequate numbers of CD34+ cells in most patients without excessive toxicity. These observations confirm previous reports that intense prior therapy adversely affects the quantity of CD34+ cells harvested. Pretreatment and posttreatment variables did not predict with any certainty the small fraction of patients who fail to yield > or = 2.5 × 10(6) CD34+ cells per kg via multiple apheresis procedures.